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Variability in emergency department electronic medical record default opioid quantities: A national survey

  • Erik J. Blutinger
    Correspondence
    Corresponding author at: Department of Emergency Medicine, University of Pennsylvania, Perelman School of Medicine, United States of America.
    Affiliations
    Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, United States of America
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  • Frances S. Shofer
    Affiliations
    Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, United States of America

    Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, United States of America
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  • Zachary Meisel
    Affiliations
    Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, United States of America

    Penn Injury Science Center, University of Pennsylvania, United States of America

    Leonard Davis Institute of Health Economics, University of Pennsylvania, United States of America
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  • Jeanmarie Perrone
    Affiliations
    Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, United States of America

    Leonard Davis Institute of Health Economics, University of Pennsylvania, United States of America
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  • Eden Engel-Rebitzer
    Affiliations
    Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, United States of America
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  • M. Kit Delgado
    Affiliations
    Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, United States of America

    Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, United States of America

    Center for Health Incentives and Behavioral Economics, University of Pennsylvania, United States of America

    Penn Injury Science Center, University of Pennsylvania, United States of America

    Leonard Davis Institute of Health Economics, University of Pennsylvania, United States of America
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Published:March 12, 2019DOI:https://doi.org/10.1016/j.ajem.2019.03.023
      While opioid prescribing for acute pain in U.S. emergency departments (EDs) is more consistent with recommendations for a 3-day or less supply than in other settings, the average number of tablets prescribed still remains highly variable [
      • Hoppe J.A.
      • Nelson L.S.
      • Perrone J.
      • et al.
      Opioid prescribing in a cross section of US emergency departments.
      ,
      • Delgado M.K.
      • Huang Y.
      • Meisel Z.
      • et al.
      National variation in opioid prescribing and risk of prolonged use for opioid-naive patients treated in the emergency Department for Ankle Sprains.
      ,
      • Barnett M.L.
      • Olenski A.R.
      • Jena A.B.
      Opioid-prescribing patterns of emergency physicians and risk of long-term use.
      ]. Furthermore, larger initial prescriptions are associated with prolonged opioid use and potential for misuse [
      • Delgado M.K.
      • Huang Y.
      • Meisel Z.
      • et al.
      National variation in opioid prescribing and risk of prolonged use for opioid-naive patients treated in the emergency Department for Ankle Sprains.
      ,
      • Barnett M.L.
      • Olenski A.R.
      • Jena A.B.
      Opioid-prescribing patterns of emergency physicians and risk of long-term use.
      ]. Setting default tablet order amounts lower than the baseline average (e.g. 10 tablets) reduces the tablet number prescribed [
      • Delgado M.K.
      • Shofer F.S.
      • Patel M.S.
      • et al.
      Association between electronic medical record implementation of default opioid prescription quantities and prescribing behavior in two emergency departments.
      ]. Conversely, if set too high (e.g. 20 tablets), prescribers are nudged into prescribing more than they would have without a default [
      • Santistevan J.R.
      • Sharp B.R.
      • Hamedani A.G.
      • Fruhan S.
      • Lee A.W.
      • Patterson B.W.
      By default: the effect of prepopulated prescription quantities on opioid prescribing in the emergency department.
      ]. It is unknown whether EDs have default orders for opioid amounts and whether these defaults are consistent with the recommended 3-day supply (typically ≤12 tablets) [
      • Cheng D.
      • Majlesi N.
      Emergency department opioid prescribing guidelines for the treatment of non-cancer related pain.
      ]. Thus, we conducted a national survey of U.S. EDs to determine the presence and size of default opioid tablet amounts.

      Keywords

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